Do You Need Hammer Toe Surgery?

Hammer Toe Surgery

When your pain is severe and conservative treatments fail to correct your hammertoe, your surgeon may determine that surgery is your best treatment option. Every patient is different, and there is no "best" surgical treatment for everyone. Instead, your doctor may "mix-and-match" several common surgical procedures to specifically tailor the treatment to best correct your hammertoes. There are many surgical options, and each procedure accomplishes a slightly different result, but some of the most common types of hammertoe surgical treatments include:

  • Resection - Removal and reshaping of bone from the PIP (proximal interphalangeal) joint.
    • As the PIP joint is often the main culprit of hammertoes, this procedure allows the surgeon to remove the rigid bony build up at the PIP joint that prevented the toe from straightening.
  • Arthrodesis - Fusion of the PIP joint to minimize motion and pain.
    • To prevent the PIP joint from returning to its crooked appearance, the PIP joint is often positioned so that bone will fill the joint. This permanently restricts the hammertoe from reappearing, and eases pain associated with the deformity.
    • Your toe is unique, in that it can be fused with minimal impact to your everyday activities, unlike other joints like your knees, shoulders and fingers. In fact, you may not even notice any difference in function compared with your normal toes.
  • Tendon transfer - The tendon that flexes your toe is re-routed from under your toe to the top, so that it pulls your toe down into proper alignment.
    • The bend at the PIP joint in your hammertoe is often caused by an unbalanced tendon that has begun pulling your toe in an unnatural position. Over time, this unbalanced state may become permanent, and your surgeon will have to move the tendon into a more balanced position through a tendon transfer.
  • Tendon lengthening/capsule release - The tendons that pull the toe up and/or down may be partially cut to relax and straighten the toe.
    • When surgery is required, the tissue around your hammertoe has begun to act as if the deformed position is normal, creating a very rigid and painful toe. To restore alignment and ease the tension on the PIP joint, this tissue may need to be trimmed through some very minor cuts of the capsule that surrounds your joint.
  • Metatarsal shortening - A portion of the long bone near the base of the toe is removed, giving the toe more space to extend itself.
    • Most shoe manufacturers design their shoes to accommodate a "normal” waterfall appearance of the toes, with the big toe being the longest, and each smaller toe being slightly shorter. However, everyone is different, and not all toes match this appearance. In fact, hammertoes are often created when a toe that is naturally longer than the surrounding toes is shoved into a shoe with a restrictive toe box, causing it to buckle.
    • Over time, this longer toe permanently maintains this crooked appearance, becoming a rigid and painful hammertoe.
    • Metatarsal shortening corrects this underlying cause of hammertoes by shortening the problematic longer toe, thereby allowing your foot to better accommodate most footwear.

Many of these procedures require the implantation of a variety of orthopaedic products to make sure the procedure works. Your surgeon may select from a variety of products, from pins to screws to a new style of implant which ensures joint fixation and stabilization. As with surgical procedures, there is no "best" product for every patient.

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